DESCRIPTION(provided by applicant): Dr. Furth is seeking the Small Grant Award to expand the study of clinical outcomes for children with end stage renal disease (ESRD) initiated under her KO8 Award DK 02586-01A1. With the support of the KO8 funding, Dr. Furth has completed her PhD in Clinical Investigation and has begun the transition to an independent research career. She has published a number of manuscripts using her training in epidemiology and clinical investigation: examining how clinical and socio-economic factors affect access to different treatment regimens for children with kidney failure, and how clinical experience with ESRD care for children affects treatment decisions. She has examined how poor growth, a crucial pediatric issue, affects mortality, hospitalization rates and educational achievement. She has also initiated a multi-center, cross-sectional study comparing functional outcomes/ health related quality of life (HRQL) for pediatric patients with chronic renal failure or ESRD treated with hemodialysis, peritoneal dialysis or transplant. Resources provided by the RO3 award will allow Dr. Furth to expand the multi-center study of health related quality of life in adolescents with ESRD to a prospective study. A prospective study will allow Dr. Furth to determine whether specific measures of health related quality of life are sensitive to clinical changes, as patients proceed from dialysis to transplantation. The supplementary funding of the R03, additionally will allow Dr. Furth to examine the link between clinical measures such as hematocrit, serum albumin, and dialysis adequacy (Kt/V) and functional outcome/HRQL. Furthermore, the prospective study will assess whether high risk behavior characterized by patterns of response on an adolescent health status questionnaire can predict non-compliance with therapy, increased hospitalization rates, acute rejection or transplant failure. The measures of functional outcome studied will include the Child Health and Illness Profile-Adolescent Edition, and the Child Health Questionnaire (Parent report). This research will provide an in-depth analysis of a measure of functional outcome in children with ESRD, and will provide valuable information regarding optimal treatment choices for children with kidney disease. If assessments of high risk behavior predict increased rates of hospitalization, rejection or transplant failure, results of this study will allow identification of a high risk population of adolescents with ESRD, who can be targeted for early intervention and close follow-up to improve long term outcomes of care. The proposal addresses several priority areas for Clinical Research highlighted in the NIH Task Force publication, Research Needs in Pediatric Kidney Disease: 2000 and beyond. During this project, Dr. Furth will gain new skills in organizing and coordinating a prospective multi-center clinical research study. This experience will give Dr. Furth the tools she needs to develop into an independent clinical investigator in a nurturing academic environment.